Department of Trauma, Hand, Plastic and Reconstructive Surgery, Translational and Experimental Trauma Research, Ulm University Medical Center, Ulm, Germany.
Department of Trauma, Hand and Reconstructive Surgery, Goethe University Frankfurt, Frankfurt, Germany.
Front Immunol. 2024 Jun 12;15:1390380. doi: 10.3389/fimmu.2024.1390380. eCollection 2024.
BACKGROUND: Extracellular particles (EPs), particularly extracellular vesicles, play a crucial role in regulating various pathological mechanisms, including immune dysregulations post-trauma. Their distinctive expression of cell-specific markers and regulatory cargo such as cytokines or micro-ribonucleic acid suggests their potential as early biomarkers for organ-specific damage and for identifying patients at risk for complications and mortality. Given the critical need for reliable and easily assessable makers to identify at-risk patients and guide therapeutic decisions, we evaluated the early diagnostic value of circulating EPs regarding outcomes in severely injured multiple-trauma patients. METHODS: Plasma samples were collected from 133 severely injured trauma patients (Injury Severity Score (ISS) ≥16) immediately upon arrival at the emergency department (ED). Patients were categorized into survivors and non-survivors. Injury characteristics and outcomes related to sepsis, pneumonia, or early (<1 day after admission) and late mortality were assessed. Circulating EPs, cytokine profiles, and blood counts of platelets and leukocytes were determined. Receiver operating characteristic analyses were conducted. RESULTS: Despite no significant differences in injury pattern or severity, non-survivors exhibited significantly elevated counts of circulating EPs compared to survivors. The optimal cut-off for EPs <200 nm indicating non-survivors was 17380/µl plasma, with a sensitivity of 77% and a specificity of 61% in predicting in-hospital mortality. Later non-survivors received significantly higher numbers of units of packed red blood cells [8.54 ± 5.45 vs. 1.29 ± 0.36 units], had higher serum lactate [38.00 ± 7.51 vs. 26.98 ± 1.58 mg/dL], significantly lower platelet counts [181.30 ± 18.06 vs. 213.60 ± 5.85 *10³/µL] and lower heart rates [74.50 ± 4.93 vs. 90.18 ± 2.06 beats/minute] upon arrival at the ED compared to survivors. CONCLUSION: Our results demonstrate the high diagnostic potential of elevated concentrations of circulating EPs <200 nm for identifying patients at risk of mortality after severe trauma. This parameter shows comparable sensitivity to established clinical predictors. Early evaluation of EPs concentration could complement assessment markers in guiding early therapeutic decisions.
背景：细胞外颗粒（EPs），特别是细胞外囊泡，在调节各种病理机制中起着至关重要的作用，包括创伤后免疫失调。它们独特的细胞特异性标志物表达和调节货物，如细胞因子或 micro-RNA，表明它们有可能成为器官特异性损伤的早期生物标志物，并识别有并发症和死亡风险的患者。鉴于需要可靠且易于评估的标志物来识别高危患者并指导治疗决策，我们评估了循环 EPs 对严重多发伤患者结局的早期诊断价值。
方法：从 133 名严重创伤患者（损伤严重程度评分（ISS）≥16）入院时立即采集血浆样本。将患者分为幸存者和非幸存者。评估与脓毒症、肺炎或早期（入院后 1 天内）和晚期死亡率相关的损伤特征和结局。测定循环 EPs、细胞因子谱以及血小板和白细胞的血球计数。进行接收者操作特征分析。
结果：尽管损伤模式或严重程度没有显著差异，但非幸存者的循环 EPs 计数明显高于幸存者。EPs<200nm 预示非幸存者的最佳截断值为 17380/µl 血浆，预测住院死亡率的敏感性为 77%，特异性为 61%。晚期非幸存者接受的单位红细胞输注量明显较高[8.54±5.45 与 1.29±0.36 单位]，血清乳酸水平更高[38.00±7.51 与 26.98±1.58mg/dL]，血小板计数明显更低[181.30±18.06 与 213.60±5.85*10³/µL]，心率更低[74.50±4.93 与 90.18±2.06 次/分钟]。
结论：我们的结果表明，循环 EPs<200nm 浓度升高对识别严重创伤后死亡风险患者具有很高的诊断潜力。该参数的敏感性与已建立的临床预测因子相当。早期评估 EPs 浓度可以补充评估标志物，以指导早期治疗决策。
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